Esophageal cancer medical therapy: Difference between revisions

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===Esophageal cancer===
===Esophageal cancer===


* '''1 Stage IV Advanced Esophageal Cancer'''
* '''1 Stage IV Non - Her 2 positive Esophageal Cancer'''
** 1.1 '''Esophagus'''
** 1.1 '''Advanced esophageal cancer'''
*** 1.1.1 '''Adult'''
*** 1.1.1 '''Adult'''
**** Parenteral regimen
**** Parenteral regimen
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***** Alternative regimen (2): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 200 mg/m2 q24h IV for up to 6 months
***** Alternative regimen (2): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 200 mg/m2 q24h IV for up to 6 months
***** Alternative regimen (3): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 625 mg/m2 q24h PO on day 1 through day 21
***** Alternative regimen (3): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 625 mg/m2 q24h PO on day 1 through day 21
 
***** Alternative regimen (4): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, oxaliplatin 130 mg/m2 IV on day 1, cepacitabine 625 mg/m2 q24h PO on day 1 through day 21
 
***** Alternative regimen (5): 42 day cycle of cisplatin 30 mg/m2 IV and irinotecan 65mg/m2 IV on days 1, 8, 15, and 22
 
***** Alternative regimen (6): 21 day cycle of oxaliplatin 130mg/m2 IV on day 1, cepacitabine 1000mg/m2 q24h PO on day 1 through day 14
 
**: '''Note (1):''' Treatment is continued until disease progression, unacceptable toxicity or patient withdrawal
 
* 2 '''Stage IV Her 2 positive Esophageal Cancer'''
 
** 2.1 '''Advanced esophageal cancer'''
 
*** 2.1.1 '''Adult'''
***** Alternative regimen (3): 21 day cycle  
**** Oral regimen
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days  
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
*** 2.1.2 '''Pediatric'''
**** Parenteral regimen
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
***** Preferred regimen (1): 21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, cepacitabine 1000mg/m2 q24h PO on day 1 through day 14, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2
***** Alternative regimen (1): [[drug name]] 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
***** Alternative regimen (1):21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, fluorouracil 800mg/m2 q24h IV on day 1 through day 5, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2  
***** Alternative regimen (2):  [[drug name]] 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) ''''''(Contraindications/specific instructions)''''''
* 3 '''Weekly Carboplatin and Paclitaxel with concurrent Radiotherapy'''
**** Oral regimen
** 3.1 '''Advanced esophageal cancer and esophagogastric junction cancer'''
***** Preferred regimen (1): [[drug name]] 50 mg/kg/day PO q8h for 14 (14–21) days  (maximum, 500 mg per dose)
*** 3.1.1 '''Adult'''
***** Preferred regimen (2): [[drug name]] '''(for children aged ≥ 8 years)''' 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
***** Preferred regimen (3): [[drug name]] 30 mg/kg/day PO q12h for 14 (14–21) days  (maximum, 500 mg per dose)
***** Alternative regimen (1):  [[drug name]] 10 mg/kg PO q6h 7–10 days  (maximum, 500 mg per day)
***** Alternative regimen (2): [[drug name]] 7.5 mg/kg PO q12h for 14–21 days  (maximum, 500 mg per dose)
***** Alternative regimen (3): [[drug name]] 12.5 mg/kg PO q6h for 14–21 days  (maximum,500 mg per dose)
** 2.2  '<nowiki/>'''''Other Organ system involved 2''''''
**: '''Note (1):'''  
**: '''Note (2)''':
**: '''Note (3):'''
*** 2.2.1 '''Adult'''
**** Parenteral regimen
**** Parenteral regimen
***** Preferred regimen (1): [[drug name]] 2 g IV q24h for 14 (14–21) days
***** Preferred regimen (1): Paclitaxel 50mg/m2 IV and carboplatin AUC 2mg/ml x min IV on day 1, 8, 15, 22 and 29
***** Alternative regimen (1): [[drug name]] 2 g IV q8h for 14 (14–21) days
**: '''Note (1):''' Given weekly for 5 weeks with concurrent radiotherapy followed by surgery
***** Alternative regimen (2): [[drug name]] 18–24 MU/day IV q4h for 14 (14–21) days
***** Alternative regimen (1): Cisplatin 100 mg/m2 IV on day 1 through 29, fluorouracil 1000 mg/m2 q24h IV on day 1 through 4 and days 29 through 32 and radiotherapy 50.4 Gy
**** Oral regimen
**: '''Note (2):''' 1.8 Gy for 5 days a week (final 5.4 Gy is given as a boost) on day 1 through 5, day 8 through 12, day 15 through 19, day 22 through 29. day 22 through 26, day 29 through 33, day 36 through 38
***** Preferred regimen (1): [[drug name]] 500 mg PO q8h for 14 (14–21) days
**: '''Note (3):''' Two courses of cisplatin and fluorouracil are given on days 1 and 29 of a 5.5 week course of radiotherapy
***** Preferred regimen (2): [[drug name]] 100 mg PO q12h for 14 (14–21) days
**: '''Note (4):''' Trimodality therapy with cisplatin and fluorouracil with concurrent radiotherapy followed by surgery
***** Preferred regimen (3): [[drug name]] 500 mg PO q12h for 14 (14–21) days
***** Alternative regimen (1): [[drug name]] 500 mg PO q6h for 7–10 days 
***** Alternative regimen (2): [[drug name]] 500 mg PO q12h for 14–21 days  
***** Alternative regimen (3):[[drug name]] 500 mg PO q6h for 14–21 days
 
 
* 1 '''Stage 2 - Name of stage'''
** 1.1 '''Specific Organ system involved 1 '''
**: '''Note (1):'''  
**: '''Note (2)''':
**: '''Note (3):'''  
*** 1.1.1 '''Adult'''
 
 
 
 
 


==References==
==References==
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Revision as of 20:26, 18 December 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Chemotherapy is used to treat advanced esophageal cancer. Chemotherapy can be used alone as monotherapy or in combination with radiotherapy or surgery. Chemotherapy may be used as a neoadjuvant therapy after surgery to kill any cancerous cells that may have been left, or as an adjuvant therapy to shrink a tumor before being surgically resected, and finally, in advanced tumors to shrink them or to relieve symptoms.


Medical Therapy

  • Some common drugs and drug combinations used to treat advanced esophageal cancer include:
    • Carboplatin and paclitaxel
      • combined with radiation
    • Cisplatin and 5-fluorouracil (5-FU)
      • combined with radiation
    • ECF: epirubicin, cisplatin, and 5-FU
      • especially for gastroesophageal junction tumors
    • DCF: docetaxel, cisplatin, and 5-FU
    • Cisplatin with capecitabine
    • Oxaliplatin and either 5-FU or capecitabine
    • Irinotecan
    • For some esophagus cancers that are HER-2 positive, chemo may be used along with the targeted drug trastuzumab or ramucirumab.

Esophageal cancer

  • 1 Stage IV Non - Her 2 positive Esophageal Cancer
    • 1.1 Advanced esophageal cancer
      • 1.1.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): 21 day cycle of docetaxel 75mg/m2 IV on day 1, cisplatin 75mg/m2 IV on day 1 and fluorouracil 750mg/m2 IV q24h from day 1 through day 5
          • Alternative regimen (1): 14 day cycle of modified docetaxel 40mg/m2 IV on day 1, leucovorin 400mg/m2 IV on day 1, fluorouracil 400mg/m2 bolus on day 1, fluorouracil 2000mg/m2 IV on day 1, cisplatin 40mg/m2 IV on day 3
          • Alternative regimen (2): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 200 mg/m2 q24h IV for up to 6 months
          • Alternative regimen (3): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 625 mg/m2 q24h PO on day 1 through day 21
          • Alternative regimen (4): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, oxaliplatin 130 mg/m2 IV on day 1, cepacitabine 625 mg/m2 q24h PO on day 1 through day 21
          • Alternative regimen (5): 42 day cycle of cisplatin 30 mg/m2 IV and irinotecan 65mg/m2 IV on days 1, 8, 15, and 22
          • Alternative regimen (6): 21 day cycle of oxaliplatin 130mg/m2 IV on day 1, cepacitabine 1000mg/m2 q24h PO on day 1 through day 14
      Note (1): Treatment is continued until disease progression, unacceptable toxicity or patient withdrawal
  • 2 Stage IV Her 2 positive Esophageal Cancer
    • 2.1 Advanced esophageal cancer
      • 2.1.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): 21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, cepacitabine 1000mg/m2 q24h PO on day 1 through day 14, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2
          • Alternative regimen (1):21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, fluorouracil 800mg/m2 q24h IV on day 1 through day 5, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2
  • 3 Weekly Carboplatin and Paclitaxel with concurrent Radiotherapy
    • 3.1 Advanced esophageal cancer and esophagogastric junction cancer
      • 3.1.1 Adult
        • Parenteral regimen
          • Preferred regimen (1): Paclitaxel 50mg/m2 IV and carboplatin AUC 2mg/ml x min IV on day 1, 8, 15, 22 and 29
      Note (1): Given weekly for 5 weeks with concurrent radiotherapy followed by surgery
          • Alternative regimen (1): Cisplatin 100 mg/m2 IV on day 1 through 29, fluorouracil 1000 mg/m2 q24h IV on day 1 through 4 and days 29 through 32 and radiotherapy 50.4 Gy
      Note (2): 1.8 Gy for 5 days a week (final 5.4 Gy is given as a boost) on day 1 through 5, day 8 through 12, day 15 through 19, day 22 through 29. day 22 through 26, day 29 through 33, day 36 through 38
      Note (3): Two courses of cisplatin and fluorouracil are given on days 1 and 29 of a 5.5 week course of radiotherapy
      Note (4): Trimodality therapy with cisplatin and fluorouracil with concurrent radiotherapy followed by surgery

References


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